Psoas abscess: report of a series and review of the literature

We describe a series of twelve patients with a psoas abscess seen in a three-year period in a university hospital and a large teaching hospital in the Netherlands. In our series, five of the 12 patients had a primary psoas abscess. The predisposing conditions were intravenous drug use, diabetes mellitus, prostate carcinoma and haematoma in the psoas muscle in a patient with haemophilia A. Seven of the 12 patients had a secondary psoas abscess. Five cases were due to vertebral osteomyelitis including two cases of tuberculosis. In the other two cases it was due to colitis and urinary tract infection. It is remarkable that in our series there was only one patient with a psoas abscess secondary to a disease of the digestive tract, while this is the most common cause of a secondary psoas abscess in the literature. There were two cases of tuberculosis which is an emerging disease again

Treatments for people who use anabolic androgenic steroids: a scoping review.

BACKGROUND: A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased greatly in recent years to support understanding of this form of substance use and the associated health harms, but there remains little evidence regarding interventions to support cessation and treat the consequences of use. In this scoping review, we identify and describe what is known about interventions that aim to support and achieve cessation of AAS, and treat and prevent associated health problems. METHODS: A comprehensive search strategy was developed in four bibliographic databases, supported by an iterative citation searching process to identify eligible studies. Studies of any psychological or medical treatment interventions delivered in response to non-prescribed use of AAS or an associated harm in any setting were eligible. RESULTS: In total, 109 eligible studies were identified, which included case reports representing a diverse range of disciplines and sources. Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. The types of conditions requiring treatment included psychiatric, neuroendocrine, hepatic, kidney, cardiovascular, musculoskeletal and infectious. There was limited evidence of engagement with users or delivery of psychosocial interventions as part of treatment for any condition, and of harm reduction interventions initiated alongside, or following, treatment. Findings were limited throughout by the case report study designs and limited information was provided. CONCLUSION: This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. More consistent reporting in articles of whether engagement or assessment relating to AAS was initiated, and publication within broader health- or drug-related journals, will support development of the evidence base

Pharmacovigilance in juvenile idiopathic arthritis patients (pharmachild) treated with biologic agents and/or methotrexate. A Pediatric Rheumatology International Trials Organisation (PRINTO)/Pediatric Rheumatology European Society (PRES) registry

Introduction: Pharmacovigilance in Juvenile Idiopathic Arthritis Patients Treated with Biologic Agents and/or Methotrexate (Pharmachild) is an international registry involving 86 centres in 32 countries from the Paediatric Rheumatology INternational Trials Organisation (PRINTO)/ Paediatric Rheumatology European Society (PReS). The registry was set up in 2011 to evaluate long term safety and efficacy profile of immunosuppressive treatments in children with Juvenile Idiopathic Arthritis (JIA). Objectives: To present data coming from the Pharmachild/PRINTO registry and analyze infections, with a main focus on opportunistic, also evaluating the relationship between infections and biologic and synthetic Disease-Modifying Anti-Rheumatic Drugs (DMARDs) in children affected by JIA. Methods: We provided descriptive statistics for demographic, clinical data, drug exposure, adverse events (AE) and events of special interest (ESI). Data from Pharmachild were combined with those coming from two national registries: BiKeR from Germany and the Swedish registry. The analysis was then focused on infections. A panel of specialists in infectious and rheumatologic diseases, identified as Safety Adjudication Committee (SAC), elaborated and approved by consensus, through three Delphi steps, a list of opportunistic pathogens for use in immunosuppressed children. Primary objective of the SAC was to adjudicate the infectious events encountered by the patients in Pharmachild with particular attention on opportunistic infections (OI). Results: Data from 8,274 patients were reported from the Pharmachild registry, and combined with those from 3,990 and 3,020 patients from the Germany and the Swedish registries, respectively, for a total of 15,284 patients. The main differences between Pharmachild and the other two registries were found in the age of onset, in the distribution of the different categories of AIG and in the use of biological drugs. The most frequently reported AE in Pharmachild resulted to be infections, adjudicated by the SAC mostly as common (88.4%). A high percentage (17.4%) of OI was reported. Among all infectious events, herpes zoster and mycobacterial infections were the most frequent. A list of OI in pediatrics was identified for subjects with JIA. Conclusions: Registries represent a powerful tool to address important issues on safety in children with JIA treated with immunosuppressive therapy. Their value can be increased by combining individual patient data from different national and international registries. The analysis of the AE in JIA patients has showed that infections are the most frequent event. However they are usually common and not life-threatening

A study of Peripheral Neuropathy in HIV infected patients

INTRODUCTION: The life expectancy of HIV-infected patients has increased as a result of highly active antiretroviral therapy (HAART). Consequently, patients and physicians are dealing with neurologic complications from the HIV disease, from concurrent diseases, and from drugs used to treat it. Peripheral neuropathy is the most common HIV-associated neurologic complication. The spectrum and the frequency of this complication are changing due to introduction of new antiretroviral drugs, an aging HIV-infected population, and the emergence of other long-term complications of HIV and/or its treatment. Several forms of neuropathy may occur, depending on the level of immunosuppression and the presence of risk factors. There is a great need for an improved understanding of these complications and their pathogenetic mechanisms, for the development of effective therapies that provide adequate symptomatic relief and halt or reverse the damage to the nerves. This work of dissertation has been done with an aim of estimating the prevalence and evaluating the risk factors associated with peripheral neuropathy in HIV infected patients of our region. AIMS OF THE STUDY: 1. To study the prevalence of peripheral neuropathy in HIV infected patients. 2. To study the risk factors associated with the development of peripheral neuropathy in HIV infected patients. 3. To study the clinical profile and various types and patterns of peripheral neuropathy in HIV infected patients. 39 MATERIALS AND METHODS: Study Design: This study is a cross sectional study. Study period This study was conducted during the period from January 2009 to December 2009, for 1 year. This Study was done in the Department of Neurology, Tirunelveli Medical College Hospital, Tirunelveli. Patient Selection: Patients attending the out patient department of Anti Retroviral Therapy (ART) Centre at Tirunelveli Medical College Hospital, Tirunelveli were taken for the study. Patients already diagnosed as HIV positive and on Highly Active Anti Retroviral Therapy (HAART) only were selected for the study. Both male and female patients were taken for the study. Study was done with the consent of the patients. Inclusion criteria: 1. Patients who were seropositive for HIV infection and registered with ART centre of Tirunelveli Medical College Hospital. 2. Patients on HAART. 3. Both symptomatic and asymptomatic patients. 4. Patients were selected irrespective of stage of the disease, CD4 count and duration of the HIV illness. Exclusion criteria: 1. HIV seropositive patients who were not on HAART at the time of the study. 2. Patients with other systemic illness like diabetes mellitus, renal disease, thyroid disease, nutritional anaemia, Hansen’s disease. 3. History suggestive of collagen vascular diseases, recent Chikunkunya fever or any other viral illness or jaundice. 4. Patients who regularly consume alcohol of > 40 units/week. SUMMARY: 1. Prevalence of peripheral neuropathy in HIV infected patients in our study is 26/60 (43.3%). 2. In our study, peripheral neuropathy is seen more in patients with advanced clinical stage and increasing age. There is no increase in prevalence of peripheral neuropathy in patients with less CD4 count. But these observations, except the age of the patients, are not statistically significant. 3. Peripheral neuropathy less commonly seen in patients on HAART of longer duration. As duration of HAART increases, peripheral neuropathy is seen more in stavudine users, suggesting drug toxicity is the cause for peripheral neuropathy rather than HIV-related. But this needs to be confirmed with neuropathological studies. 4. Distal symmetrical polyneuropathy is the common type (20/26). Common pathological pattern of neuropathy is mixed (both axonal and demyelination) neuropathy (18/26). 5. All patients who had symptoms of peripheral neuropathy had electrophysiological evidence of peripheral neuropathy. Likewise all patients with signs of peripheral neuropathy had electrophysiological evidence of peripheral neuropathy. Hence detailed history and clinical examination for symptoms and signs of peripheral neuropathy is essential in all HIV infected patients as it can pick up more number of patients with peripheral neuropathy earlier and so they can be treated earlier. 6. Among the 5 patients (who didn’t have either symptoms or sings of peripheral neuropathy) who underwent nerve conduction study, 1 had electrophysiological evidence of peripheral neuropathy. So subclinical peripheral neuropathy present in 20% (1/5) of patients. But this needs to be evaluated with large number of patients. 7. Numbness and tingling were the common and burning pain and pins and needles sensations were the less common symptoms seen in our patients. Diminished or absent ankle jerks, impaired vibration, touch, pain and temperature were the common signs. 8. Symptoms and signs were more common in lower limbs than in upper limbs

Identifying, recording and monitoring adverse effects associated with antriretroviral treatment

South Africa, with an estimated 5.7 million people living with HIV, continues to have one of the largest epidemics in the world. The introduction of HAART resulted in prolonged and improved quality of life of many infected patients. However, adverse effects caused by these drugs have become a major concern as they affect the adherence of patients and in some cases even result in the death of patients. Although much research has been and is still being conducted in the area of understanding, preventing and management of ARV adverse effects, there is still a need for patients to be actively involved in self-monitoring for adverse effects. This will assist health care professionals in early identification of serious or potentially serious ARV effects. This study aimed at evaluating the usefulness of strategies developed and employed in the identification, recording and monitoring of adverse effects. The study was conducted with patients receiving HAART from a private HIV and AIDS clinic in Uitenhage, Eastern Cape, South Africa. The research project was approved by the Nelson Mandela Metropolitan University Research and Ethics Committee and the research site. This was an experimental, randomized controlled study carried out over a period of three months (August to October 2009), with a sample size of 160 patients divided into four study groups of 40 patients each. Two monitoring strategies, namely an ARV adverse effect monitoring tool and a patient self-monitoring diary were developed and used for the identification and recording of adverse effects. The four study groups included a Control group, a Tool group, a Diary group and a Tool-Diary group. Willing patients, after signing an informed consent form, were randomly assigned to one of the four groups by participating health care workers at the study site. Data was retrieved from the patient files by the researcher. Descriptive statistical analysis of the findings of the study was conducted using SPSS®. One hundred and forty nine patients were included in the final data analysis. Of the 80 diaries handed out to patients, only 33 were returned and due to errors only 31 were suitable for analysis. Monitoring tools were completed and analysed for 36 patients. The tool was found to be more effective in identifying adverse effects of a physical nature (such as peripheral neuropathy and lipodystrophy) than the usual methods of monitoring employed by the clinic, whilst the diary, used alone, was found to be less effective. Use of the tool and diary combined resulted in the most significant identification and recording of central nervous system related adverse effects and physical adverse effects. However due to the low return rate of the diaries and the majority of the monitoring tool not being completed in many instances the results of this study may not be generalisable. The study results did however suggest that combining the tool and the diary methods of adverse effect identification, yielded the most favourable results when compared to each method alone. This may be attributed to the fact that the tool is useful in identifying objective symptoms and the diaries subjective symptoms, particularly in instances where the patients forget to report their symptoms to healthcare professional whilst at the clinic. The diaries were also reported to improve adherence for more than 90 percentage (n=31) of the patients. More research would be needed in order to verify the exact significance of the tool and the diary in identifying and recording adverse effects and symptoms of adverse effects

The impact of DAA treatment on HIV/HCV co-infected individuals across Europe: Analyses of co-infection data from a European cohort study

With the introduction of safe and highly efficacious direct-acting antivirals (DAAs), elimination of HCV has become more viable. The World Health Organisation set the targets of reducing HCV incidence and mortality by 2030 to achieve this goal. To meet these goals, increased consideration is required of those most at risk of HCV, such as people living with HIV (PLWH) due to the shared routes of transmission. Data from the EuroSIDA study has been used to investigate the epidemiological characteristics of HIV/HCV co-infected individuals in Europe, with a specific focus on regional differences in DAA effectiveness and treatment outcomes. My findings show that there were major gaps at all stages of the HCV continuum of care among PLWH for all regions in 2015, with only 78% of anti-HCV positive individuals receiving a HCV-RNA test, 47% of those HCV-RNA positive starting HCV treatment and 23% achieving SVR. By 2017 there were improvements in the transition of individuals through stages after improved access to DAAs, as 83% of individuals who were anti-HCV positive were HCV-RNA tested, 61% of those HCV-RNA positive received treatment, and 42% achieved SVR. Among individuals treated with DAAs who had a known treatment response, 91.5% achieved SVR12. There was no evidence of regional differences, indicating high rates of SVR12 can be achieved across all European regions in real-world settings. The proportion of individuals who were reinfected within 24 months of achieving SVR was 7.7% among HIV/HCV co-infected individuals, with evidence of regional differences. There was also evidence to suggest that the odds of individuals being reinfected decreased over time. The findings from these studies highlight the effectiveness of DAAs and their positive impact on the outcomes of HIV/HCV co-infected individuals. However, to achieve the goal of HCV elimination by 2030, improvements in HCV screening and access to DAAs is urgently required